How many secure mental health beds did you say there were?

“A teenager who was a risk to himself and the public could not be found a secure mental health bed for a month in England, Scotland or Wales, his father claims.”

So what’s the real story? How many secure beds are there? For young people?

I have trawled through 46 NHS Trusts, looking for Forensic units for children and adolescents. Wikipedia describes Forensic thus:

“Forensic psychiatry is a sub-speciality of psychiatry and is related to criminology. It encompasses the interface between law and psychiatry. A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process and provide treatment like medications and psychotherapy to criminals.

United Kingdom

In the UK, most forensic psychiatrists work for the National Health Service, in specialist secure units caring for mentally ill offenders (as well as people whose behaviour has made them impossible to manage in other hospitals). These can be either medium secure units (of which there are many throughout the country) or high secure hospitals (also known as Special Hospitals), of which there are three in England and one in Scotland (The State Hospital, Carstairs), the best known of which being Broadmoor Hospital. The other ‘specials’ are Ashworth hospital in Maghull, Liverpool and Rampton hospital in Nottinghamshire. There are also a number of private sector medium secure units, which sell their beds exclusively to the NHS, as there are not enough secure beds available in the NHS system.

Forensic psychiatrists often also do prison inreach work, in which they go into prisons and assess and treat people suspected of having mental disorders; much of the day-to-day work of these psychiatrists comprises care of very seriously mentally ill patients, especially those suffering from schizophrenia. Some units also treat people with severe personality disorder or learning disabilities. The areas of assessment for courts are also somewhat different in Britain, because of differing mental health law. Fitness to plead and mental state at the time of the offence are indeed issues given consideration, but the mental state at the time of trial is also a major issue, and it is this assessment which most commonly leads to the use of mental health legislation to detain people in hospital, as opposed to their getting a prison sentence.

Learning disabled offenders who are a continuing risk to others may be detained in learning disability hospitals (or specialised community-based units with a similar regime, as the hospitals have mostly been closed) as suffering from “mental impairment” in England and Wales, and without use of that term in Scotland. This includes those who commit serious crimes of violence, including sexual violence, and fire-setting. They would be cared for by learning disability psychiatrists and registered learning disability nurses (RNLD). Some psychiatrists doing this work have dual training in learning disability and forensic psychiatry or learning disability and adolescent psychiatry. Some nurses would have training in mental health also (RMN and RNLD).“

The ones listed by Wikipedia are for adults. Children and young people need them too.

Here is what I found: 

Gardener Unit, Prestwich Hospital, Manchester 

10 beds. Boys only. Medium Secure

“Gardener Unit provides care for young people with serious mental illness or concern of a significant psychiatric disorder with significant levels of risk. These will be young people who require assessment and/or treatment and/or rehabilitation, and who could not otherwise safely receive this in a non-secure hospital setting or custody setting. The service aims to maximise young people’s hope about their future, enabling them to develop safe indepentent living and promoting opportunities for positive achievement. The unit is recovery-oriented with recovery being client-centred. The Gardener Unit team recognise the unique and diverse needs of young people and provide quality residential care.

The Gardener Unit is one of a number of medium secure adolescent forensic units across the country providing highly specialised care in a secure environment.  The unit contains ten beds and is for boys between the ages of 11 and 18 years. Within the unit is a purpose built intensive care facility”

 

The Wells Unit, Regional Secure Unit, Uxbridge Road, Southall UB1 3EU

10 Beds. Boys only. Secure

“The Wells unit is a ten bed male inpatient unit for adolescent young men aged between 12 and 18 years, which is part of the secure forensic mental health service for young people.

We provide a highly specialised, multi-disciplinary assessment and treatment service for young males aged between 12 and 18 years with severe mental illness who are a danger to themselves or others, and who may have committed criminal offences.

There is no catchment area as the beds are part of a national service.”

 

Alnwood, St Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon TyneNE3 3XT

22 Beds. Mixed. Medium Secure

“Ashby is a 9 bed unit providing comprehensive assessment and treatment for young people aged 12-18 with complex mental health disorders and a requirement of a high level of supervision in a medium secure environment.

Wilton is a 6 bed unit providing comprehensive assessment and treatment for young people aged 12-18 with complex mental health disorders and a requirement of a high level of supervision in a medium secure environment.

Lennox is a 7 bed unit providing comprehensive assessment and treatment for young people aged 12-18 with complex mild to moderate learning disability and a requirement of a high level of supervision in a medium secure environment.

Referrals are accepted from specialist mental health teams regionally, nationally and internationally. Informal enquiries are welcomed and advice can be given by telephone prior to referrals.”

The article I was looking at says there are 1,440 hospital beds, many of which are 50 miles apart. I have found 42 within the Medium to Secure range. That either means that I haven’t been able to find them all in the few hours I’ve been researching this, all the other beds are non secure, or, there simply aren’t enough beds.

My next thought was: how many children offend and how many of those are classed as being a mental health risk? I am hoping (not very confidently I admit) that there isn’t much need for high security child detention.

I’ve found some crime figures for Youth Offending from the Ministry of Justice. I haven’t been able to find mental health figures, but that can be worked out logically. The custody population 2016/2017 for males under 18 averaged at 925 per month. The average for females under 18 was 36 per month. Which makes 959 people under 18 each month. One in 4 people suffer from mental illness, so a quarter of that total is  239.75 people who may need mental health treatment.  Not all of them will need to be hospitalised, but 42 beds still sounds scarily low.

We are talking here not only of the care and safety of the offenders, but also the safety of other people. Surely the argument that other people may be at risk should make more mental health beds (secure and otherwise) for children a priority?

Confession time. I have violent tendencies. Towards myself mostly. But there have been 2 occasions in my life when other people were hurt. People I loved.

So this isn’t just some do-gooder spouting off. I sort of know a bit about how depression and addiction can spiral out of control.

Prison for me is a “yet”. I haven’t been there yet. I could have though.